Recently, deaths caused by all-terrain vehicle (ATV)-related incidents were summarized for West Virginia for the period 1985 to 1997. According to the US Consumer Product Safety Commission (CPSC), the 113 ATV-related deaths reported in West Virginia for this period accounted for nearly 4% of the national total (2976), and the state ranked seventh among all states in ATV-related deaths. Preliminary CPSC data for 1998 added another 19 ATV-related deaths in West Virginia. Although studies over the past 15 years have addressed risk analysis for and effects of regulations on ATV-related incidents, the risk of such incidents in pediatric populations, and the prevention of injuries resulting from incidents involving ATVs, the elderly (persons 65 years or older) are generally not identified as a subset of the population vulnerable to such incidents. During the 14-year period from 1985 to 1998, 11 elderly men (but no elderly women) died of traumatic injuries sustained in ATV-related incidents in West Virginia, accounting for 8% - or nearly twice the national percentage - of the 132 ATV-related deaths verified by the CPSC in West Virginia during this period. None of the deaths were work related. The state population-based ATV-related fatality rate for West Virginia of 5.7 per 1 00.000 persons between the ages of 65 and 74 years was about 8 times the overall national rate of 0.7 for persons in this age group. Table I summarizes key demographic and other factors in ATV-related deaths in West Virginia from 1985 to 1998. Statistical comparisons of ATV-related fatalities involving the elderly with those involving other population groups in West Virginia from 1985 to 1998 are problematic because of the few deaths among the elderly. Nevertheless, several of the risk factors identified in ATV-related fatalities within this age group merit comment. A CPSC review indicated that helmet use reduces the risk of death in ATV-related incidents by about 42%. Nevertheless, although all 3 age groups involved in fatal ATV-related incidents had an extremely low rate of use of helmets, the 2 youngest groups experienced a high proportion of head and neck injuries, whereas the elderly more often experienced fatal trauma to the upper and lower trunk. The elderly may suffer from poor vision, reduced muscle strength and coordination, and polypharmacy, which may exacerbate the inherent dangers associated with ATVs and produce different crash dynamics than in incidents involving younger ATV operators. Additionally, although the CPSC data cited in this letter provide little information about driver experience in fatal incidents involving ATVS, a recent analysis of the effects of training estimated that novices were involved in more than 40% of the deaths associated with these vehicles. Because riding in ATVs continues to gain popularity, and because West Virginia has the oldest population among all states in terms of median age and one of the highest proportions of elderly persons in the United States, more ATV-related deaths among the elderly can be expected in West Virginia unless important safety concerns relating to these vehicles are addressed. The CPSC, in concert with organizations such as the All-Terrain Vehicle Safety Institute, the American Academy of Orthopaedic Surgeons, and the American Association of Retired Persons, should continue to develop and endorse appropriate guidelines and training for the safe operation of ATVs and should encourage the use of approved helmets and other protective equipment by these vehicles' users. Training courses should be made available and accessible to all ATV users, including the elderly, and should include information on starting and stopping, turning, climbing, descending, and riding across slopes in these vehicles. Other elements of training in the use of ATVs should address these vehicles' mechanical components, including inspection of their tires, throttle, brakes, lights and switches, oil and fuel, and drivetrain and chassis before each occasion on which they are used. (A)
Samenvatting